saying this is what we wanna be when we grow up, you know?

And I know I certainly didn't, you know?

I didn't ask for it.

I didn't ask for addiction, I didn't ask for homelessness.

Even up here in the alleyway where this steam blowing, it's warm, very warm.

- [Isabella] Maureen Sumner was 41 years old when she became homeless.

She spent six years living on the streets in Rhode Island.

- Warmer months were easier, as you would imagine, but when it got colder, that's when I would start getting nervous, like, "Oh, what are we gonna do?"

- [Isabella] She says shelters were often not an option.

- They're not the safest.

They're not the cleanest.

They have 101 criteria that you have to meet.

So we just stopped trying.

We made our home a tent, and that's what we had to deal with for months and months and years and years.

- [Isabella] Sumner's story is not unique.

According to the Department of Housing and Urban Development, about 1200 people are currently experiencing homelessness in Rhode Island.

On this night in March, Dr. Rebecca Karb walks the streets trying to help people living outside.

Karb is an emergency room physician who's become acutely aware of the challenges facing Rhode Island's homeless population.

- Even folks that have Section 8 vouchers or other kinds of subsidies, like still can't find a place to rent with the resources that they have 'cause it's just too expensive.

There also aren't enough shelter beds in Rhode Island.

- [Isabella] But the problem is not exclusive to the streets.

Karb says it's in the emergency room too.

- So we see people experiencing homelessness every day or some form of housing insecurity.

- [Isabella] Many come in for medical treatment, but all too often, it's about simply finding a warm place.

- They might come in for shelter on a night when the weather's really bad, or, you know, it's particularly cold, and they don't have a safe place to go.

- There's a lot of like deep cubbies in these buildings, and depending on which buildings you go to, you're not really bothered as long as you're out of there, you know, at a decent time.

And decent time, I mean, 5:30, at 6:00 AM.

- [Isabella] When Maureen Sumner was living on the streets, she would spend endless nights in the cold with her partner.

- We were sleeping in a child's tent behind the region, Sea Sign, that's where we had our first tent.

And it was quite scary.

I mean, anything could happen.

- [Isabella] She was recovering from addiction, but Sumner said the conditions led her back to using heroin and crack cocaine.

- I wanted to get high to pretty much pass out and just make it to the next morning.

Nobody wants to live that way, you know?

And I don't give my addiction an excuse.

I'm not giving any of it an excuse.

- Did you ever go to the emergency department for shelter too?

- Oh yeah, of course we all have.

As long as you had a bracelet, that said, you know, you were being seen, but you had to leave at 6:00 AM, which was fine.

I'm like, "Okay, I was in here all night," you know?

- [Isabella] Under normal conditions, space comes at a premium in hospitals across Rhode Island.

Covid and staffing shortages have made the problem even worse.

- When you only have a handful of beds in a big ER, and you have 30, 40, 50, 60 people waiting in the emergency department, in the waiting room of our emergency department, that sometimes puts us in a bind regarding who we can keep there.

There's a beating heart at the center of what we all do.

- [Isabella] Jay Baruch is an emergency physician in Rhode Island and author of the book, "Tornado of Life: A Doctor's Journey Through Constraints and Creativity in the ER."

- Hypothermia is a terrible risk for them.

And dying from hypothermia is a tragedy.

- [Isabella] Baruch says that nearly every shift, someone comes into the ER for shelter, some twice a day, returning just hours after being discharged.

Some come after being turned away from shelters.

Others because they see the ER as a safer option.

It's a moral dilemma that Dr. Baruch struggles with regularly.

- You don't send that back out in the street at an ungodly hour and unconscionable weather, and then you look into the waiting room, and there are oftentimes very sick people who've been waiting for hours and hours and hours and hours.

So they don't get our compassion.

Compassion for this person means you're not compassionate to the other person.

And it's a zero sum game.

- [Isabella] A zero sum game that Baruch is obliged to play.

In addition to long waits, studies show that emergency room crowding can have dangerous consequences, like increased violence against hospital staff, increased risk of medical errors, and sometimes death.

- I mean, it's hard on a number of levels because we are the safety net for all of these kind of broken systems.

But we are a safety net that doesn't have the resources or tools to address the problem.

We are trained to solve and treat medical emergency, right?

(laughs) So if you like have a heart attack or break a limb, or, you know, have a gunshot wound, you can come in, and we are on it.

We've got it taken care of.

But if you come in because you don't have a home, we don't have the solution to that.

- Prior to Covid, we did have enough shelter beds, and now we have what's called a crisis assessment to allocate the shelter beds that we have.

We don't really understand how they can just say, "Well, it takes time."

Well, yeah.

But that's 'cause you have a roof over your head.

- [Isabella] Eric Hirsch is an activist and professor of sociology at Providence College.

For the past 30 years, he's been researching and working to end homelessness.

- We're still, I would say two or 300 beds short.

- [Isabella] When we asked him about people turning to the ER for shelter, he wasn't surprised.

- When you have no place to go, particularly if the weather is severe, our outreach workers tell people to go to emergency rooms because they're warm.

Generally you can stay there.

Although now we also are seeing that the ER doctors and other people, nurses and other people there are telling people to leave.

So now we're actually telling people if they're forced to leave, to go back in and say they have chest pain.

- Many others would say, "Hey, the ER is to address my emergency medical needs.

This isn't the appropriate place for that.

The crowding affects access to care."

- I totally agree with that.

The ER is not the right place for people who are homeless, but we're not providing an alternative.

This is a matter of survival.

- Do you have any, you know, idea, you know, how much that costs?

- You're talking about millions of dollars potentially even for one person over let's say a couple of years.

Not meeting the housing needs of people, turns out to be more expensive than meeting them.

All the taxpayers are paying for leaving people outside.

- [Stefan] Let's do that, can I just take a quick look?

- Yeah.

- [Isabella] Rhode Island's new Secretary of Housing, Stefan Pryor, is the latest person tasked with improving the housing situation.

We recently followed him on a visit to a shelter in Westerly.

- What's the most you could do?

- The most I most I could do outta here?

- The most on average.

- And average, 60 per meal, 65.

- Pryor's appointment followed the resignation of the state's first housing secretary, Josh Saul.

Saul was criticized for sitting on $250 million of federal aid that was earmarked for housing.

What is the status of housing and homelessness in Rhode Island right now?

- We are not building enough housing in Rhode Island.

If you look at the building permits for residential dwellings, we have one of the worst, if not the worst, on a per capita basis, housing-start scenario in the country.

- [Isabella] The impacts have been dramatic.

Housing Works Rhode Island has reported that more than a third of people in this state are burdened by housing costs.

And according to realtor.com, from 2021 to 2022, Providence area rents jumped nearly 24%, the fifth highest increase in the country.

- We need to move towards a world where there's permanent supportive housing and the vouchers for subsidies necessary to help vulnerable in individuals afford these homes.

- [Isabella] On Sunday mornings, Matthewson Street Church serves a hot breakfast for anyone who needs it.

Maureen Sumner is a regular.

It's a hub for most homeless people in the area.

In the basement, where clothes are given out for free, Sumner catches up with her friend who has been living at Harrington Hall's shelter for the past three years.

- Grateful for the roof over my head that they provide, but I would like my own bathroom.

- Right.

- [Isabella] In 2020, Sumner was in a car accident that shattered her hip.

After waking up from an induced coma, she found out she had finally gotten off the wait list for a housing voucher.

But many of her friends are still homeless.

- I usually have people come like couple nights a week.

I wish I could help everybody.

I wanna bring 'em all home, you know?

But it's not the reality of it.

- She's also working towards becoming a peer mentor to help her friends who are still out on the streets.

What's it like moving in here?

- Oh my goodness, I didn't care how much my hip hurt.

I was moving whatever I could up these stairs myself.

(laughs) I was just so excited.

And, you know, after everybody left and helped me set up a few things, I just kind of sat there and cried.

You know, 'cause I was grateful, you know, and I was proud.

(gentle music) (gentle music continues) - Up next, hundreds of children in Rhode Island